Healthcare Provider Details

I. General information

NPI: 1316861263
Provider Name (Legal Business Name): EAMON WHELAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 METRO DR
WARRINGTON PA
18976-2744
US

IV. Provider business mailing address

30 N 23RD ST APT 2114
PHILADELPHIA PA
19103-1594
US

V. Phone/Fax

Practice location:
  • Phone: 267-486-3337
  • Fax:
Mailing address:
  • Phone: 203-942-4199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22DI03174000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: